Car Fitting You and Your Client for Best Practice

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Car Fitting You and Your Client for Best Practice
Meredith Sweeney, OTR/L, CDI, CDRS and Tina
Young, DRS, MSOT, OOTA Older Adult MSG
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AOTA Older Driver Initiative Mission

• The mission of the American Occupational Therapy
• Associations (AOTA) Older Driver Initiative is
  to
• Build the capacity of occupational therapy
  programs to address the needs of at risk senior
  drivers, with the goal of ensuring IADL
  independence, including driving, for as long as
  safely possible and to
• Develop a toolkit of resources for occupational
  therapy program development.

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Objectives

1. Define Senior Tsunami and the relationship with
   older driving.
2. Understand your role in driving and the general
   overall process.
3. Be able to identify the many available sources of
   information, tools and references.
4. Overview of AOTA, AARP, AAA CarFit Program

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Senior Driver Tsunami Coming

• What is it?
• Why is it important?

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Aging and Driving
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(NHTSA, n.d.)
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Driving and Demographics

• The number of older licensed drivers in the US is
  expected to increase
• from 20 million today to 40 million in 2020.
• Graph is for drivers 70 years and older
• Most older drivers are safe! However.

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Driver Rehabilitation Services East Carolina
University
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Fatalities
http//search.cga.state.ct.us/dtSearch_lpa.html
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Driver Rehabilitation Services East Carolina
University
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78 Million Baby Boomers

• What does that mean?
• NIH - 1 in 7 over 71 years of age have some type
  of dementia (Plassman et al. 2007)
• Ohio
• In 2008, 1,573,570 over 65
• 224,796 with dementia
• 205 BMV offices in Ohio
• 1,096 per office

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Anne Dickerson, PhD, OTR/L, FAOTA East Carolina
University
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Dementia and Driving Warning Signs

• Needing more help with directions or learning a
  new driving route
• Having trouble remembering the destination of the
  trip or where the car is parked
• Getting lost in unfamiliar places
• Having trouble making turns
• Feeling confused when exiting a highway or by
  traffic signs
• (Drive Well, 2005)

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Dementia and Driving Warning Signs

• Receiving citations for moving violations
• Stopping at green lights or braking
  inappropriately
• Drifting out of road lane
• Causing damage to ones car and not being able to
  explain what happened
• Having difficulty controlling emotions while
  driving
• (Drive Well, 2005)

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Older Driver Diagnoses that Impact Driving

• Dementia/Alzheimers Disease
• Vision Loss
• Diabetes
• Parkinsons Disease
• CVA
• TBI
• Cardiovascular

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Driver Rehabilitation Services East Carolina
University
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Normal Aging Progression that Impacts Driving

• Sensory vision, hearing and perception
• Cognitive memory, attention, judgment and
  executive functioning skills
• Physical reaction times, strength and
  flexibility

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Ashley Christopher, OTS, CHES and Amy Wentz, OTS
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Medications that Impact Driving

• Anti-Depressants
• Wellbutrin
• Cymbalta
• Lexapro
• Anti-Histamines
• Benadryl
• Zyrtec
• Claritin
• Allegra
• Benzodiazepenes
• Xanax
• Ativan
• Diazepam (Valium)

• High Blood Pressure
• Cardura
• Atenolol
• Lopressor
• Pain Killers
• Darvocet
• Percocet
• Vicodin
• Lorcet

Ashley Christopher, OTS, CHES and Amy Wentz, OTS
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Senior Driver Tsunami Coming

• OT Involvement / Role
• General Process

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Impact on OT

• Special issues with Driving
• Can it be done by BMV Evaluators?
• Issue 1 Need more driving specialists
• Issue 2 Need tools that are effective,
  efficient, utilized by others than driving
  specialists.

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Anne Dickerson, PhD, OTR/L, FAOTA East Carolina
University
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Occupational Therapy

• Community mobility is under IADL
• Moving around in the community and using public
  or private transportation, such as driving,
  walking, bicycling, or accessing and riding in
  buses, taxis.
• Rural communities Driving is the only
  community mobility option.
• Comprehensive OT treatment will address the
  clients home and community mobility status

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Driver Rehabilitation Services East Carolina
University
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Algorithm for Driving and Community
MobilityAssessment, Referral, Training

• Using the Occupational Therapy Practice
  Framework Domain and Process, 2nd edition,
  American Occupational Therapy Association, 2008

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Author Dr. Anne Dickerson, East Carolina
University
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Protocol to Evaluate Older Drivers
Handout from Geriatrics, August 2005, Volume
60, Number 8, p.24
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Driver Rehabilitation Specialists

• Professionals with specialized training in
  driving evaluation, training and rehabilitation.
• ADED Association for Driver Rehabilitation
  Specialist
• 80 of DRS are Occupational Therapists
• CDRS Certification administered by ADED
• American Occupational Therapy Association
• Specialty Certificate in Driving and Community
  Mobility

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Driver Rehabilitation Services East Carolina
University
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Role of the Driver Rehabilitation Specialist in
Assessing Older Driver Safety

• Provide objective data regarding abilities
  required for driving
• Assure that abilities are within State
  regulations.
• Relate abilities to skill performance of the
  actual driving task.
• Help client and family think about driving safety
  for the present and future.

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Driver Rehabilitation Services East Carolina
University
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Who Does Driving Evaluations?

• Varies depending on state, setting, staff,
  training
• BMV or licensing authority
• Structured, same for all
• Pass/fail
• Medical review board
• Driving Rehabilitation Specialists
• Individualized
• Screen or evaluate sub-skills
• Performance in Context On Road

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Driver Rehabilitation Services East Carolina
University
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Overview of theAssessment Process

• Client History
• Physical Assessment
• Functional Mobility
• Reaction Time
• Visual/Perceptual
• Visual Acuity
• Depth Perception
• Color Discrimination
• Contrast Sensitivity
• Field of View
• Cognitive
• Road Signs
• Behind the Wheel
• Recommendations

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Driver Rehabilitation Services East Carolina
University
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Treatment Components in the Clinic

• What to do
• IADL components

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What Older Drivers Can Do To Improve Their
Driving

• Maximize Physical, Visual and Cognitive Health.
• Become a student of their medications
• Maintain a realistic perspective related to
  experience, ability and the driving environment.
• Understand dangers such as crowded
  intersections, unprotected left turns, driving
  when stressed or fatigued.

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Driver Rehabilitation Services East Carolina
University
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What Older Drivers Can Do To Improve Their
Driving

• Maximize VISION and the aspects of driving that
  affect vision.

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Driver Rehabilitation Services East Carolina
University
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What Older Drivers Can Do To Improve Their
Driving

• Cease night driving.
• Compensate for decreased reaction time.
• Avoid in-car distractions.
• Plan ahead.

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Driver Rehabilitation Services East Carolina
University
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What Older Drivers Can Do To Improve Their
Driving

• Communicate
• Check Mirrors
• Implement safe lane changing procedures
• Implement safe backing procedures

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Driver Rehabilitation Services East Carolina
University
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What Older Drivers Can Do To Improve Their
Driving

• Look for driver opportunities.
• Be proactive when in comes to your safety and
  public safety.
• CarFit

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Driver Rehabilitation Services East Carolina
University
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Tips for Safe Driving

• Before Driving
• Be rested and alert
• Be calm, not upset or angry
• Do not take medications which will interfere with
  your driving prior to driving
• Scan the road a mile ahead, and keep the big
  picture in mind
• (AARP, n.d.)

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Ashley Christopher, OTS, CHES and Amy Wentz, OTS
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Tips to Compensate for Blind Spots

• Be aware of other drivers blind spots and do not
  ride in them
• Practice flexibility exercises each day
• Glance over each shoulder
• You will always have blind spots, no matter what
  type of vehicle you drive
• (AARP, n.d.)

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Ashley Christopher, OTS, CHES and Amy Wentz, OTS
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Tips for Safe Backing

• Do not depend completely on your mirrors
• Turn your head and look out the rear window
• Make sure the space behind your vehicle is clear
• (AARP, n.d.)

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Ashley Christopher, OTS, CHES and Amy Wentz, OTS
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Tips for Driving in Adverse Weather

• Dont use cruise control in bad weather
• (AARP, n.d.)

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Ashley Christopher, OTS, CHES and Amy Wentz, OTS
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Tips for Avoiding a Head-on Crash

• If a crash cannot be avoided, try to sideswipe
  instead of hitting head on
• It is better to hit something else rather than
  another vehicle moving
• (AARP, n.d.)

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Ashley Christopher, OTS, CHES and Amy Wentz, OTS
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Other Forms of Transportation

• Family, friends and neighbors
• Public Transit (taxi, bus, railways, limo)
• Non-profit or faith-based transportation
• Private businesses
• Try out all these options before you actually
  need to depend on them
• (AARP, n.d.)

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Ashley Christopher, OTS, CHES and Amy Wentz, OTS
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Driving Transitions Education

• Driving Transitions Education Program
  http//www.asaging.org/asav2/drivewell/driving_tra
  nsitions.cfm
• ASA funded by NHTSA
• Modules and Scripts
• How to interact with family members
• Practice Exercises use with other professionals

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Anne Dickerson, PhD, OTR/L, FAOTA East Carolina
University
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Professionals Direct Service

• http//www.nhtsa.dot.gov/portal/site/nhtsa/menuite
  m.31176b9b03647a189ca8e410dba046a0/
• Older Driver Programs
• Information for Older Drivers
• Brochures as resources
• Research and Reports
• Resources for People Around Older Drivers
• Links to Other Organizations
• Research reports

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Anne Dickerson, PhD, OTR/L, FAOTA East Carolina
University
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NHTSA Resources for Direct Service

• All of these are links to information on the
  site
• Occupant Protection issues among older drivers
  and passengers
• How to understand and influence older drivers
• Family and friends concerned about an older
  driver
• Driving safely while aging gracefully
• Safe driving for older adults
• Assessing and counseling older adults
• Cues for law enforcement
• Turning the corner and still driving
• Physicians guide to assessing and counseling
  older drivers
• Adapting motor vehicles for older drivers

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Anne Dickerson, PhD, OTR/L, FAOTA East Carolina
University
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Physicians Guide to Assessing and Counseling
Older Drivers

• Chapter 5 The Driver Rehabilitation Specialist
• www.ama-assn.org/go/olderdrivers

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Anne Dickerson, PhD, OTR/L, FAOTA East Carolina
University
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AAA Foundation for Traffic Safety

• Good resources
• 4 highlights
• Get on their mailing list

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Anne Dickerson, PhD, OTR/L, FAOTA East Carolina
University
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Professionals Direct Service

• AARP, ASA same information
• Show how to find a driving rehab specialist
• AOTA Website http//www1.aota.org/driver_search/
  index.aspx
• ADED Website http//www.driver-ed.org/custom/dir
  ectory-cdrs/?pageid320showTitle1
• Share about CarFit
• http//www.car-fit.org/
• Best setting for CarFits
• Share caregivers information
• Deal with same issues

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Anne Dickerson, PhD, OTR/L, FAOTA East Carolina
University
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The Fit Between You and Your Vehicle

• Just as important as a mechanical check-up
• Proper adjustments of head restraints, and
  safety belts and air bags
• CarFit See Handouts
• (AARP, n.d.)

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Ashley Christopher, OTS, CHES and Amy Wentz, OTS
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What is CarFit?

• Educational program to check if an older adult
  fits their car
• Provides community-specific resources to enhance
  driver safety.
• Developed by
• AARP
• American Automobile Association
• American Occupational Therapy Association.

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Driver Rehabilitation Services East Carolina
University
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Resources

• Developing and Delivering Educational
  Presentations Anne Dickerson, PhD, OTR/L,
  FAOTA, East Carolina University
• Keeping Drivers on the Road The Occupational
  Therapists Role Anne Dickerson, PhD, OTR/L,
  FAOTA and Cyndee Crompton, MS, OTR/L
• Managing Senior Mobility Across the Western
  Continents Jim Langford, Australia Michelle
  Porter, Canada Lisa Molnar, USA Anne Dickerson,
  PhD, OTR/L, FAOTA, East Carolina University
• 60 Going on 16 Knowledge to Keep Older Drivers
  on the Road - Ashley Christopher, OTS, CHES and
  Amy Wentz, OTS

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Our Contact Information

• Meredith Sweeney, OTR/L, CDI, CDRS
• Tina Young, MSOT, OTR/L
• Grady Memorial Hospital OhioHealth
• 561 West Central Avenue
• Delaware, OH 43015
• [phone]

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